Provider Demographics
NPI:1790761930
Name:GREAVES, JOHN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GREAVES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 BENTLEY CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3761
Mailing Address - Country:US
Mailing Address - Phone:215-990-2993
Mailing Address - Fax:215-918-0130
Practice Address - Street 1:910 BENTLEY CT
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3761
Practice Address - Country:US
Practice Address - Phone:215-990-2993
Practice Address - Fax:215-918-0130
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN266974L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00668232OtherRAILROAD MEDICARE
S51887Medicare UPIN
PAP00668232OtherRAILROAD MEDICARE
PA007182Medicare ID - Type Unspecified